Laserfiche WebLink
`VELUPUNT IP PERMIT PAYMEN11 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION RECENEE <br /> `f 304 E.WEBER AVE.. STOCKTON CA 95202 (209)163-3-120 <br /> ' �'✓ ` NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED' �l I y 2 2 2000 <br /> �J <br /> JOB ADDRESS \ \� \� \` ,1 `.� � \ �iC �_'�. y ;_ ^aCt''•. 11NT� <br /> 17 <br /> HEALt;+'ERYICH <br /> PARCEL SIMAPN /JLI� l ! t 1 CITN'IZIP 4. <br /> OWNER NAME ADDRESS <br /> CITY/ZIP�._i �i•i L f i �/� J.' JL( PHONE �P` <br /> CONTRACTORi l l'L (0:'/I l^%u i l i.(_ i I.f J.ADDRESS <br /> CITY/zip L I(-t 6(, /) i f'A illy, 'A I PHONE <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSHIP RANGE SECTION <br /> TYPE OF WELL: NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL# ❑OTHER <br /> INSTALLATION: ❑ WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELL# <br /> Y14EW <br /> TYPE OF PUMP: ❑REPAIR H.P. DEPTH PLvIP SET FT. FIRST WATER LEVEL❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL.# ❑SOIL BORING ❑DESTRUCFIO`: <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DI �V I CONDUCTOR CASING DIA <br /> ❑ DOMESTIC PRIVATE RAVEL PACK/SIZE WELL CASING TYP4�{/—�-f ( WELL C;.SING DIA <br /> r / <br /> ❑PUBLIC.MUNICIPAL ❑DRIVEN GROUT SEAL DEPTH :?ECIFICATION <br /> IRRIGATION/AG OTHER GROUT BRAND NAME <br /> ❑MONITORING 2 R N C)-rt C GROUT SEAL PUMPED: C AT^S ❑NO a <br /> ❑CHRISTY BOX ❑STOVE PIPE V ES1-EEp ONCRETE PEDESTAL BY DRILLER: C�_ES ❑NO <br /> APPROXIMATE WELL DEPTH �Z (� , <br /> PROPOSED CONSTRUCTION/DRILLING METHOD: NIUD ROTARY AIR ROTARY AUGER CABLE OTHER <br /> I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE-N AD <br /> CCORANCE WITH SAN <br /> JOAQUIN COUNTY O /ANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIG <br /> TITLE: DATE: <br /> Lo <br /> CN <br /> a � <br />